Ontario’s palliative care doctors are warning that the government is not ready for “an imminent spike in the number of people facing end-of-life.”

In a Dec. 10 release, the Ontario Medical Association section of palliative medicine said it’s nice Queen’s Park is putting money into new hospice beds, but it’s not enough.

“We were pleased to see the Ontario Government’s announcement confirming that it will fund some new residential hospices,” said the release, but the increasing number of elderly is putting pressure on end-of-life care.

The Ministry of Health and Long-Term Care announced it was “moving forward with plans to build 193 new hospice beds across Ontario.” It is investing $33.6 million for the beds, plus an additional $20.3 million in operational funding once they are open.

The financing had been put in place more than a year ago by the previous Liberal government.

However, new hospice beds on their own won’t close the gap on palliative care, said Toronto palliative care doctor and chair of the OMA Section of Palliative Medicine Dr. Bill Splinter.

“There’s still, unfortunately, a lot of needless suffering that’s going on that shouldn’t be going on,” he said.

Palliative medicine in Ontario needs both more trained and dedicated personnel and more palliative beds, whether in hospices or hospitals, Splinter said. While 87 per cent of Canadians could benefit from palliative care at end-of-life, only 15 per cent are receiving it, according to a recent report by the Canadian Institute for Health Information.

With almost two-thirds of Canadians dying in a hospital bed, more palliative care represents an opportunity to reduce costs, said Splinter. A residential hospice bed is roughly one-third the cost of a hospital bed.

“We don’t actually need to add dollars to the system. We need to redirect the dollars,” said Splinter.

EDMONTON – Citing the needs of fragile patients, Covenant Health has clarified how assessments are done in its facilities for patients who want to end their lives under provisions of Canada’s assisted suicide and euthanasia law.

Legalized in 2016, the assisted suicide law allows a physician to administer a lethal medication or provide the means for a patient to do so. However, the law goes against Covenant Health’s mission and Catholic ethical tradition, “to uphold the inherent dignity of every human being throughout the entire continuum of life from conception to natural death.”

Last year at least two patients had their MAiD assessments done outside in public areas around Covenant Health facilities. Since then, every patient exploring assisted suicide has had their assessment completed on site.

On Dec. 3, Covenant Health went further. It released a revised MAiD policy after consultations with more than 100 individuals and groups including doctors, Catholic bishops, Alberta Health Services, the Alberta government, patient advisers, families, ethicists and community members.

Under the policy, witnessing and signing of legal documents and assessments of eligibility can take place on Covenant Health sites. Patients deemed eligible for medically induced death would be transferred to other facilities.

“It’s not a starting point of ‘Well, we don’t do that,’” said Gordon Self, chief ethics officer for the Catholic health-care provider, which runs 17 facilities located in 12 communities across Alberta.

“It’s a starting point of trying to understand where a person’s coming from and tending to some of their own inner thoughts and concerns. And then, if they are interested in pursuing a service which we don’t provide — whether it’s MAiD or cardiac surgery — there’d be appropriate referral mechanisms.”

Critics welcomed the new policy, but said it doesn’t go far enough.

Sandra Azocar, executive director of Friends of Medicare, wants to see provisions made to allow assisted deaths on Covenant Health sites, not just the assessments, especially in rural Alberta where health care options are limited.

“If the physicians don’t feel it’s something they can do — they have moral objections to it — allow other health-care professionals to accommodate it by having a specific area, or room, especially in rural communities,” Azocar said.

OTTAWA – Palliative care advocates are applauding a new national framework document that has adopted an international definition of palliative care that excludes euthanasia and assisted suicide as elements of patient care.

Released Dec. 4, Canada’s national palliative care framework has endorsed the World Health Organization (WHO) definition which states palliative care should “neither hasten or postpone death.”

“It’s a great thing that they decided to go with the World Health Organization definition,” said Conservative MP Marilyn Gladu. “That precludes people that are delivering palliative care from performing MAiD (medical aid in dying) as well.”

Gladu said there is pressure in British Columbia to include euthanasia and assisted suicide in palliative care.

“It’s of great concern because people that are providing palliative care should not in any way be hastening death,” she said.

“That is the WHO definition and that’s what’s in place in provinces like Quebec and most of the rest of the country and that’s the model we should stick with,” she said.

“Palliative care is about caring for the physical, psychological, social and spiritual needs as a person’s life is coming to an end,” he said. “It’s not supposed to be about ending their life.”

The national document was produced as a result of a private member’s bill by Gladu that passed into law a year ago with unanimous all-party support. It required Parliament develop a national framework for palliative care by Dec. 11, 2018.

The framework document reports that, although 75 per cent of Canadians would prefer to die at home, 60 per cent die in hospitals. Only 15 per cent of Canadians have access to palliative home care services, and those with access to these services are 2.5 times more likely to die at home than in a hospital emergency department or intensive care unit.

Tabled by Health Minister Ginette Petitpas Taylor, the framework calls for the creation of an Office of Palliative Care (OPC), funded by Health Canada, to co-ordinate and improve palliative care across federal, provincial and territorial jurisdictions. This office would also connect the many stakeholders in palliative care and raise public awareness.

Gladu welcomed the creation of the OPC, but said much depends on who the government appoints to run it.

“It needs to not be a bureaucrat,” she said. “It needs to be someone familiar with palliative care to help drive the plan forward.

“The framework contained all the elements we were hoping to see in there, from the training of different levels of health care providers, to infrastructures that may be needed to help get that consistent access across the country,” said Gladu. “We saw data collection and research — care and support for the caregivers. I think the right elements were there.”

“They are going to spend the next year or two to figure out exactly what they want to do,” she said.

Gladu is also disappointed that no new money was attached to the framework, and that very little of the $6 billion pledged previously by the Liberal government to go towards palliative care and home care has been spent.

“In fact, they have extended the time line to now be from 2017 to 2027 in terms of how the $6 billion will roll out,” she said.

Overall, however, she said the “this framework does have the right elements, it is a plan marching us in the right direction to get consistent access for all Canadians.”

As Parliament awaits the imminent arrival of a report on assisted suicide that may make a bad situation even worse, it’s worth noting some chilling stories from the first countries to legalize medically induced death. This could be our future.

In Belgium, which legalized euthanasia in 2002, two doctors and a psychiatrist face charges over the alleged fatal poisoning of a woman. According to news reports, the woman persuaded doctors she met the legal threshold for euthanasia by claiming she had Asperger’s syndrome, a disorder on the mild end of the autism spectrum. Her death was not imminent — not even close — but she claimed to be suffering unbearably. Belgium permits euthanasia for psychiatric reasons and, based on the woman’s petition, her doctors approved her death by lethal injection. She was 38.

Subsequently, her two sisters claimed she was not autistic, but simply depressed after a relationship ended. She received no treatment from doctors for her alleged autism, which made it impossible to declare that her condition was unbearable or incurable, the sisters said. Belgium authorities found sufficient evidence to support that claim and sent the doctors to trial on charges that carry a maximum penalty of life imprisonment.

This all came about soon after prosecutors in The Netherlands charged a doctor for ending the life of a senile woman. It is alleged that he put a sedative in the woman’s coffee and, as family members held the woman down, administered a lethal injection against her will. Two similar cases are also being investigated, and how many unknown or unreported incidents of abuse of the law have occurred is anyone’s guess.

These types of scenarios — where individual doctors interpret the law according to their personal ethical and moral standards — are bound to some day come to Canada if, as many recommend, the country’s two-year-old euthanasia legislation is expanded to permit easier access for those who have given up on life. Parliament will consider amending the law after it receives a report some time this month on the issues surrounding euthanasia for mature minors and the mentally ill, both of which are permitted by law in Belgium and The Netherlands, but forbidden in Canada.

It’s conceivable that the review being conducted by the Council of Canadian Academies will shut the door on the wisdom of expanding euthanasia, but more likely it will leave the door open at least a crack. The world is passing through an era in which the sanctity of human life is being steadily devalued. To its discredit, Canada is close behind nations like Belgium and The Netherlands in that regard.

Once the line has been blurred between natural death and medically inflicted death, it becomes easy to lose sight of it altogether. It’s happening abroad. There’s no reason to believe it won’t happen here.

OTTAWA – Ontario doctors who are suing the Ontario physicians’ college over conscience rights received good news Nov. 8 when the province of Ontario dropped its intervention on behalf of the college.

“I don’t know exactly the details why the Attorney General decided to back off as an intervener, but it’s certainly encouraging for our side and we are hoping the College of Physicians and Surgeons of Ontario (CPSO) will lose some of their support in this matter and their case will become weaker,” said Dr. Ryan Wilson, president of Canadian Physicians for Life (CPL), one of the applicants in the lawsuit launched by five Ontario doctors, CPL, the Christian Medical and Dental Society Canada and the Canadian Federation of Catholic Physicians’ Societies.

“It is good in the sense that it communicates to the court that the government is not necessarily supportive of the Charter violations the policies cause,” said Albertos Polizogopoulos, the constitutional lawyer who represents the applicants in the case scheduled for a hearing Jan. 21-22.

While the move indicates the Progressive Conservative government may not support the College’s position the way the previous Liberal government did, Wilson remains disappointed the Ontario Attorney General has not introduced legislation to protect the conscience rights of health care workers the way Manitoba has.

“This kind of case could never happen in Manitoba because health care workers are protected by legislation,”Wilson said. “So, in Ontario, we were hoping the same would happen under the Ford government.”

While Premier Doug Ford and other leadership candidates supported conscience rights during last June’s election campaign, Canadian Physicians for Life, which represents thousands of physicians across Canada, is also disappointed the Ontario Progressive Conservative Party will not include a resolution to support health professionals’ conscience rights at its policy convention Nov. 16-18 in Toronto.

“We tried to introduce a grassroots policy at the PC convention, to make it a party matter,” Wilson said. “It didn’t make it through the policy committee.”

That means it would not be heard on the convention floor or voted upon, he said.

“We found that quite outrageous,” Wilson said. “It’s something voters were told would be an issue and a Ford government would protect health care workers. It seemed very undemocratic for the policy committee to slash a resolution that had quite widespread support, especially among Conservative voters.”

Wilson points out the CPSO “is being far more aggressive than any jurisdiction in the country,” noting other colleges state conscience rights as part of their policy, though some are more vague.

“Ontario is the only one that says you have to either participate in or refer to someone who will participate” in euthanasia, abortion and other procedures, “and that’s why we feel so strongly this has to be opposed actively in the court as well as in the legislature.”

“The upcoming policy convention has been rigged,” said Jack Fonseca, senior political strategist for Campaign Life Coalition (CLC). “The corrupt, liberal-progressive establishment within the PC Party filtered out a grassroots policy on conscience rights, which had broad grassroots support, and to my knowledge had been submitted by many different PC members from different parts of the province.”

Jeff Gunnarson, the president of CLC, said at least 12 socially-conservative policy resolutions did not make it to the convention floor.

“We want to believe that Doug Ford — a man who is for the people — had nothing to do with the filtering of grassroots policies, and that it was party bureaucrats instead,” Gunnarson said in a release. “Regardless, he needs to fix it.”

Speaking to more than 1,600 guests at the 39th annual Cardinal’s Dinner in Torontoon Nov. 8, the cardinal urged them to resist any attempt to expand the federal euthanasia law to include minors.

“The time for review of the federal euthanasia law is upon us, and there is great pressure to eliminate the so-called ‘safeguards’ which made it seem to be not so terrible,” he told the audience at the Metro Toronto Convention Centre.

“One such safeguard is that euthanasia is to be only for adults. Now we hear arguments made that the concept of ‘adult’ is to be made so elastic that even minors are to be eligible for euthanasia, even without the consent of their parents. The cold shadow of euthanasia is spreading further in our land, and we must resist that.”

A government committee is expected to deliver a report next month that examines extending assisted suicide to youth under 18, psychiatric patients and consenting adults who give an advance directive to be euthanized in the event they become incapacitated by illness or disease.

The cardinal stressed the need for access to palliative care. “That, not euthanasia, is the way forward,” he said.

“When people are lonely and feel that they are useless, and that life is not worth living, we must reach out, in practical love and support. Each person is worthy of life and of our love.”

Chaired by Tom Woods, chair of the Integrated Health Network of Providence, St. Joseph’s and St. Michael’s Healthcare, the dinner featured head table guests from several layers of government, as well Apostolic Nuncio Archbishop Luigi Bonazzi.

The central theme of Collins’ speech was on the importance of Catholic heath care, although he also acknowledged several issues that have been in the news, including the “terrible evil” of the attack on the Pittsburgh synagogue, the plight of Christians suffering religious persecution in the Middle East, and the Church’s sex abuse scandal.

“We must always be vigilant and continue zealously to eliminate corruption from the Church,” he said in reference to the abuse. “Above all we must remember that the pain of what was suffered in the past continues into the present for those who endured this great evil. We must never cease to do whatever we can to help all victims of abuse.”

In his speech, Collins called Catholic health care a “bright light of hope in this valley of tears.”

Acknowledging a history of healing that goes back to Mother Delphine Fontbonne and continued with the Sisters of St. Joseph, Collins said the the institutions of Catholic health care are “united in a common mission rooted in the Gospel.”

“In any worthwhile enterprise, we must be clear about our identity: about who we are,” he said. “That is true as well of Catholic health care. Some here present are directly engaged in this great work, but all of us benefit from it, and all of us need to consider what makes it what it is.”

Collins described Catholic health care as being “especially dedicated to caring for those who are marginalized — ‘the least of my brethern.’”

Collins said two themes essential to Catholic health care are reverence for the human person and the “sacrificial love of strangers.”

“Reverence for the dignity of the human person determines the way we treat the beginning, the middle, and the end of life,” he said.

“We all come to the end of this journey of earthly life,” he said. “We are destined to die. But we must never take a human life – another’s or our own – for it is not ours to take: we are stewards, not owners, of the life entrusted to us by God. With the tragic introduction into our country of euthanasia, we must insist that we do not do that. Bringing about the death of a patient is just plain wrong.”

Collins went on to said that the foundation of Catholic health care is built on the love known as “agape,” or “the practical sacrificial love of strangers.”

“First, it is sacrificial – as in laying down one’s life for one’s friends,” he said. “When we sacrifice we let go of the ego, and forget ourselves in order to serve another.

“Secondly, the love that is the motivation for Catholic health care in the imitation of Christ the Healer is practical: not a matter of pretty words, but of practical action. The model here is Jesus at the last supper: he gets down on his knees and washes the feet of his disciples, and invites them to do likewise. Our love must be down to earth and practical.”

On rare occasions I get clear signals of what needs to be done in my life. When it comes, it arrives through people I respect. Each gives me the answer I need but I did not know I needed till I heard it.

It has fortunately come when I feel stuck at some crossroads and do not know which way to go. I mull it over and over but never move forward. My confusion builds and soon a sense of frustration descends.

Frustration to me is a red light that despair, a mortal sin, is next.

In late 2013 I was still recovering from massive spinal surgery but I decided to try to go back to work at the National Post. I did not last long. When I took morphine to deal with the pain things were a blur; when I skipped the morphine the pain was so bad I could not concentrate.

I mentioned this to my doctor. She said, “Have you thought of retiring?” An hour later I was in the office of my physiotherapist and without prompting she asked, “Why are you still working?” The next morning my wife said over breakfast, “Don’t you think it’s time to quit?”

And so on a Monday morning I said farewell to the National Post, a gut-wrenching decision I knew I could no longer avoid.

There is the great story of a man stuck on his roof as floodwaters rise around him. He is certain God will come to his aid. Several rescuers come through the course of the day and offer him a way to safety — but each time he refuses believing God will intervene directly. Then the waters rise, drowning the poor man. When he gets to Heaven he complains to God that He never sent him the help he needed. To which God replies, “Who do you think sent those rescuers?”

I truly believe that God was telling me it was time to let go and he used three good women to make sure I did not drown in my own doubts and fear.

Now I have heard a new message that has also come in threes.

As many of you know, I have been attacking legalized euthanasia for ages. And many of you also know that I have a bad habit of complaining when others do not take it as seriously as me.

I call it: “Frustrated Prophet Syndrome.”

To some extent my frustration is justified. Euthanasia is an evil. What has been especially alarming to me of late is the shrug of the shoulders that has greeted a Health Canada study looking at extending euthanasia to teens and the mentally ill. A report is due out by the end of the year.

To make matters worse, The Catholic Register dropped this bombshell in October:

“In a prestigious medical journal, doctors from Toronto’s Hospital for Sick Children have laid out policies and procedures for administering medically assisted death to children, including scenarios where the parents would not be informed until after the child dies.”

The silence that has greeted this has been frightening.

So I brought this sense of frustration to two priests. Their message boiled down to this: Fix myself first. Eradicate my own sins. Pray more. Live a life that reflects the love of the Father. Live a life that indicates Christ has died for me so I may attain eternal life. Show more joy. Cut the whining.

Then a few weeks ago I attended an Opus Dei retreat for men. The speaker, a friend, talked about the chaos we are witnessing in the Church and the need for unity. He spoke about respect for Pope Francis even when we disagree with him. He talked about how to put the recent revelations of abuse into some perspective, while at the same time recognizing the crimes committed in our name.

Then he spoke about personal holiness. That at times like these the best thing we can do is fix ourselves. As this same friend said to me later: Gloominess born of despair sends the message we have given up on God. Whereas joy sends the message that we trust God’s providence.

St. Julian of Norwich said it best: “All will be well, all manner of things will be well.” I pray it so.

VANCOUVER – The rate of medically-assisted deaths on Vancouver Island is about five times higher than in the rest of the country.

A new report from the Vancouver Island Health Authority has revealed 3.6 per cent of all 504 deaths on the island in the first two years since Bill C-14 were assisted suicides, and the rate has since increased to four per cent. For the rest of Canada, the rate is less than one per cent.

“British Columbia has been at the forefront of the political move and legal challenges that have resulted in Bill C-14 (allowing) access to assisted dying,” one of the report’s authors, Dr. David Robertson, told the Victoria Times Colonist.

Robertson suggested that history is why more people are dying of assisted suicides on Vancouver Island than anywhere else in the country.

Robertson also said Vancouver Island has an “unusually high number” of doctors willing to end their patients’ lives, which means more access to assisted death.

The report noted it took the Netherlands 15 years for the number of deaths by assisted suicide to rise to 3.9 per cent of total deaths.

It also said of all islanders who went through with medically assisted suicides, 57 died at home, 26 per cent in acute-care hospitals, 12 per cent in hospices or palliative care units, and three per cent in residential or assisted care.

The top reasons patients gave for requesting assisted deaths were cancer (61 per cent), organ failure (19 per cent) and neurodegenerative disease (8 per cent). The average age was 76.

EDMONTON – At what point does a health care provider become complicit in the act of medically-assisted death?

As more patients seek euthanasia or assisted suicide in Alberta, Covenant Health, one of the country’s largest Catholic health care providers, is gaining more experience in making that call, including from a case that made headlines and prompted an apology from the institution.

As of Sept. 30, there have been 486 assisted suicides in Alberta since so-called Medical Assistance in Dying (MAiD) was legalized in June 2016. Of those, 64 patients were transferred from a faith-based facility that does not provide the service.

Covenant Health was not able to provide the number of its patients who have been transferred from its sites for assessments, but at least one of those transfers didn’t go smoothly.

In the spring of 2017, Doreen Nowicki was 66 and terminally ill with amyotrophic lateral sclerosis, also known as ALS or Lou Gehrig’s disease. She was receiving palliative care at the Edmonton General Continuing Care Centre operated by Covenant Health. CBC News revealed in a report on Oct. 23 that she was forced to have her assessment for assisted suicide on the sidewalk outside the facility after the hospital refused to allow it on their premises, despite having originally approved it.

The event went against Covenant Health’s mission to provide compassionate care, said CEO Patrick Dumelie.

“We ultimately concluded that we didn’t do everything we should’ve done to support this patient and family,” he said. “It’s really important for us as a compassionate, caring organization living our mission, that we don’t abandon people when they’re at their highest need. And so if you’re contemplating taking your own life, there’s no time that you’re more vulnerable. Something like this is really an adverse event. This isn’t how the system functions.”

Nowicki’s request for assisted death was eventually met through Alberta Health Services and she died June 5, 2017. For its part, Covenant Health has apologized to the family and learned from the experience, Dumelie said.

Covenant Health considers health care an “immense responsibility and a calling,” Ed Stelmach, the board chair and former Alberta premier, said at its annual community meeting on Oct. 24.

“It’s also challenging work and sometimes we don’t get it right, as you might have read in the news,” said Stelmach. “It requires humility and a commitment to learn and improve.”

Dr. Owen Heisler, Covenant Health’s chief medical officer, said the Catholic health care provider has since improved its system of determining who may have medically assisted death assessments done on its premises and who should leave their facility for assessments.

Covenant Health participates in some of Alberta Health Services’ five stages that people go through when they are considering medical assistance in death, including the “Pre-Contemplation” stage, where a patient is seeking information, and the “Contemplation” stage, where they might make an informal or formal request for more information.

“We’re happy to have that discussion with them,” said Heisler.

Covenant Health does not participate in the third stage, “Determination,” where assessments are done to see if they meet the criteria, or the fourth stage, “Action,” where the patient’s life is ended.

The fifth stage, “Care after Death,” is where grief support and follow-up is provided for the family.

“After that happens, there’s a lot of distress. We’re more than happy to participate in five, talking to the family to make sure the loved one is respected and the family is respected,” said Heisler.

The assessment stage, where an AHS navigator, or coordinator, meets with the patient and the family to determine whether the patient is a candidate for medical assistance in dying, is not allowed to be done on Covenant Health premises. Exceptions can be made in the case of “an extraordinary need,” said Heisler.

The Covenant Health policy providing exceptions to having assessments done on site is a measure of compassion, Dumelie said.

“We don’t want to do more harm to the individual. We don’t want to treat them in a way that could even push them toward medical assistance in dying.”

When a patient is considering medical assistance in dying, Covenant Health’s policy is to seek ways of improving their palliative care, Dumelie added.

It’s distressing to know that doctors from Toronto’s Hospital for Sick Children have published an article on how best to extend voluntary euthanasia to children. This is sad but not surprising, as Canada both at home and abroad pushes to extend the culture of death.

The state decides what is good “care” for the patient, and what is not, including the appropriate time to intentionally kill. That a sick child or person is most often not capable of making a responsible decision is of no concern. Society says we must respect the patient’s “right” to end his life. This is similar to the insane idea that students have the “right” to transgender without the parents being informed. What the self wants, not family and God, is paramount.

The medical goal should be to save lives and do no harm. Instead, the authors corrupt the aim by suggesting efficient ways to kill. To give patients the autonomy to be killed and then pay doctors to find economical ways do so is not medical care. It’s reducing life to a product, one more thing to use and abuse and then discard at will.

Canada is in terrible need of architects of the culture of life and true care.

Lou Iacobelli,

Toronto

Vote wisely

A recent news report mentioned that the Halton Catholic District School Board trustees had cancelled a motion disallowing various charities from benefiting from school-run fund-raising because of connections to causes whose agendas contained elements contrary to Catholic teaching. This move followed protests from students and parents. The majority of trustees bowed to the will of the protesters.

On Oct. 22 parents and taxpayers will have the task of electing not only city mayors and councillors, but also their representative on the school board. In the case of the latter group, the trustees will be answerable not only for the financial and material welfare of the students, but also for their spiritual welfare. It is a heavy responsibility.

Let us hope Catholics in Ontario take care to elect trustees whose values are not in conflict with Catholic teachings and who make sure to eschew the secular attitudes often promoted by some candidates. These are the people we entrust with our most precious resource, our children.

C. Daffern,

Scarborough, Ont.

Anger and sadness

Let us be brutally frank here. You can be sure that the crisis we are seeing in dioceses and seminaries all over the U.S., Chile and elsewhere is a worldwide epidemic of an active homosexual network that has infested the Catholic Church. It fills me with anger and sadness when I see you denying the credibility of Archbishop Carlo Maria Viganò’s letter.

Christine Oskirko,

Barry’s Bay, Ont.

Identifying writers

There is a clear division in the Catholic Church today. On one side are those emphasizing the traditional focus of the Church on life and the family according to St. John Paul II and past popes. On the other side are those emphasizing the altered focus of the Church on the environment and immigration according to Pope Francis.

As an avid Catholic Register reader, I would find it most helpful if your writers, including your columnists, would share their ecclesiastical orientation by identifying themselves with a simple TC for Traditional Church or AC for Altered Church. This would be a big help in positioning the writer in the reader’s mind and in helping the reader overcome a longstanding problem of determining where the writer is coming from.